Rules on foreign GPs 'must be tightened' after Ubani death case

Tighter regulations must be brought in to prevent a repeat of the case of Dr Daniel Ubani, who killed a pensioner with an overdose of painkillers on his first and only shift in Britain, doctors heard.

Nigerian-born Dr Ubani flew into the UK from Germany and injected Dr David Gray, 70, with 100mg of a pain relief drug - 10 times the recommended dose.

He was struck off the medical register earlier this month after being found guilty of making "recurrent mistakes".

Dr Ubani's first application to work in the UK in Leeds failed after he did not get a high enough score on an English test.

A subsequent application, however, was approved in Cornwall, and he eventually went to work in Cambridgeshire.

Dr Hamish Meldrum, chairman of the British Medical Association (BMA) told delegates at the BMA's annual conference that a similar case must never arise.

He said the UK "seemed to be able to do little or nothing to check that doctors from overseas - especially from Europe - meet the proper standards of language and competence".

The UK had benefited enormously from overseas doctors and would continue to do so but the Ubani case "has shocked us all", he said.

He added: "It cannot be acceptable for poorly trained, badly regulated doctors whose knowledge of English is about as good as my knowledge of Chinese, to be able to practise - virtually unchallenged - in the UK."

The Government and the General Medical Council (GMC), which regulates doctors, are in discussion about EU rules on language testing.

The GMC is prevented from testing ability in English or the clinical competence of doctors from the EU, but can do so for those from the rest of the world.

An EU directive on the issue says any language testing should be proportionate, not blanket testing, and should happen only in cases where there is doubt over proficiency.

The UK's 1983 Medical Act provides a barrier to the GMC by not mentioning English tests for EU doctors at all, effectively preventing it from carrying them out.

Niall Dickson, chief executive of the GMC, has said it "remains extremely concerned that the current arrangements do not provide patients with the protection they need".

Dr Meldrum insisted today the situation had not arisen as a result of the 2004 GP contract, which allowed doctors to opt out of providing out-of-hours care in return for around a 6,000 drop in salary.

"That is rubbish," Dr Meldrum said. "It has been caused by under-funding and mismanagement of out-of-hours services by too many primary care organisations and by poor enforcement of, admittedly, inadequate regulations."

He said his sympathy went out to the family of Dr Gray "but sympathy is not enough".

"We must ensure that the doctors who treat our patients are competent to do so, that they have the necessary language skills and that they are subject to the same regulation as UK doctors."

Health trusts can carry out their own language tests, but MPs said in April that this was patchy.

The Commons Health Select Committee warned NHS trusts "were not doing their jobs", meaning patients risked being treated by doctors who were incompetent or were not fluent in English.

The MPs said ministers should push for changes to the current rules to allow checks by the GMC.

Health Secretary Andrew Lansley said today: "We are working closely with the GMC to ensure that foreign healthcare professionals are not allowed to work in the NHS unless they have proven their competence and language skills, and we are currently exploring a number of options to put a stop to foreign doctors slipping through the net."

Dr Gray, who was suffering from kidney stones, died at his Cambridgeshire home in February 2008 after being given the massive overdose of diamorphine by Dr Ubani.

The 67-year-old German, a specialist in cosmetic medicine based in Witten, admitted causing the pensioner's death after confusing it with another drug.

He was given a nine-month suspended sentence in Germany for death by negligence but still works as a doctor there.

Dr Meldrum said EU rules which promote free movement of labour "must not trump patient safety".

He said that in the case of Dr Ubani, even those checks that were in place were not working properly.